Refractory Hypokalemia as a Clinical Manifestation of Ectopic Cushing Syndrome: A Report of Two Cases and a Review of the Literature
PDF (Español (España))
HTML (Español (España))

Keywords

Cushing syndrome
ectopic ACTH secretion
hypocalemia
neuro endocrine tumor
metabolic alcalosis

How to Cite

Coronel Restrepo, N., Mejía Zuluaga, M., Aristizabal, N., & Torres Grajales, J. L. (2019). Refractory Hypokalemia as a Clinical Manifestation of Ectopic Cushing Syndrome: A Report of Two Cases and a Review of the Literature. Revista Colombiana De Endocrinología, Diabetes &Amp; Metabolismo, 6(1), 42–50. https://doi.org/10.53853/encr.6.1.467

Abstract

Cushing’s syndrome (CS) is a set of signs and symptoms caused by the excess of free cortisol in the plasma. Its clinical manifestations are multiple and sometimes not very specific, making its clinical diagnosis difficult. The confirmation of hypercortisolism is a thorough out process that must be done in order to obtain an adequate and accurate diagnosis. The following are two cases of cancer patients whose paraneoplastic clinical manifestation, due to ectopic adrenocorticotropic hormone (ACTH) secretion and associated cushing syndrom, was a severe hypokalemia refractory to conventional treatment. Following the approach presented in the different endocrinology societies, a diagnostic flow chart of patients with hypokalemia is presented and an updated review of the literature regarding ectopic CS.

https://doi.org/10.53853/encr.6.1.467
PDF (Español (España))
HTML (Español (España))

References

1. Pivonello R, De Martino MC, De Leo M, Lombardi G, Colao A. Cushing’s Syndrome. Endocrinol Metab Clin North Am. Marzo de 2008;37(1):135-49.
2. Kreitschmann-Andermahr I, Psaras T, Tsiogka M, Starz D, Kleist B, Siegel S, et al. From first symptoms to final diagnosis of Cushing’s disease: experiences of 176 patients. Eur J Endocrinol. Febrero 6 de 2015;172(3):285-9.
3. Ilias I, Torpy DJ, Pacak K, Mullen N, Wesley RA, Nieman LK. Cushing’s Syndrome Due to Ectopic Corticotropin Secretion: Twenty Years’ Experience at the National Institutes of Health. J Clin Endocrinol Metab. Agosto de 2005;90(8):4955-62.
4. Findling JW, Raff H. DIAGNOSIS OF ENDOCRINE DISEASE: Differentiation of pathologic/neoplastic hypercortisolism (Cushing’s syndrome) from physiologic/non-neoplastic hypercortisolism (formerly known as pseudo-Cushing’s syndrome). Eur J Endocrinol. Mayo de 2017;176(5):R205-16.
5. Prague JK, May S, Whitelaw BC. Cushing’s syndrome. BMJ. Marzo 27 de 2013;346(mar27 3):f945-f945.
6. Lacroix A, Feelders RA, Stratakis CA, Nieman LK. Cushing’s syndrome. The Lancet. Agosto de 2015;386(9996):913-27.
7. Nieman LK, Biller BMK, Findling JW, Newell-Price J, Savage MO, Stewart PM, et al. The Diagnosis of Cushing’s Syndrome: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. Mayo de 2008;93(5):1526-40.
8. Gutiérrez-Restrepo J, Román-González A. Síndrome de Cushing ectópico: revisión de la literatura. Rev Colomb Cancerol. Octubre de 2016;20(4):175-82.
9. Isidori AM, Kaltsas GA, Pozza C, Frajese V, Newell-Price J, Reznek RH, et al. The Ectopic Adrenocorticotropin Syndrome: Clinical Features, Diagnosis, Management, and Long-Term Follow-Up. J Clin Endocrinol Metab. Febrero de 2006;91(2):371-7.
10. Oronsky B, Ma PC, Morgensztern D, Carter CA. Nothing But NET: A Review of Neuroendocrine Tumors and Carcinomas. Neoplasia. Diciembre de 2017;19(12):991-1002.
11. Asa SL, Kovacs K, Vale W, Petrusz P, Vecsei P. Immunohistologic localization of corticotrophin-releasing hormone in human tumors. Am J Clin Pathol. Marzo de 1987;87(3):327-33.
12. Alexandraki KI, Grossman AB. The ectopic ACTH syndrome. Rev Endocr Metab Disord. Junio de 2010;11(2):117-26.
13. Raffin-Sanson ML, Massias JF, Dumont C, Raux-Demay MC, Proeschel MF, Luton JP, et al. High plasma proopiomelanocortin in aggressive adrenocorticotropin-secreting tumors. J Clin Endocrinol Metab. Diciembre de 1996;81(12):4272-7.
14. Aschner P, Jácome A, Jiménez L, de Anzola MI. Síndrome de secreción ectópica de ACTH por un carcinoma de células en avena del pulmón. Acta Medica Colombiana. Diciembre de 1985;10(6):259.
15. Lee Hamm L, Hering-Smith KS, Nakhoul NL. Acid-Base and Potassium Homeostasis. Semin Nephrol. Mayo de 2013;33(3):257-64.
16. Barbosa SL-S, Rodien P, Leboulleux S, Niccoli-Sire P, Kraimps J-L, Caron P, et al. Ectopic adrenocorticotropic hormone-syndrome in medullary carcinoma of the thyroid: a retrospective analysis and review of the literature. Thyroid Off J Am Thyroid Assoc. Junio de 2005;15(6):618-23.
17. Kakade H, Kasaliwal R, Jagtap V, Bukan A, Budyal S, Khare S, et al. Ectopic ACTH-Secreting Syndrome: A Single-Center Experience. Endocr Pract. Noviembre de 2013;19(6):1007-14.
18. Newell-Price J, Morris DG, Drake WM, Korbonits M, Monson JP, Besser GM, et al. Optimal Response Criteria for the Human CRH Test in the Differential Diagnosis of ACTH-Dependent Cushing’s Syndrome. J Clin Endocrinol Metab. Abril de 2002;87(4):1640-5.
19. Colao A, Faggiano A, Pivonello R, Pecori Giraldi F, Cavagnini F, Lombardi G, et al. Inferior petrosal sinus sampling in the differential diagnosis of Cushing’s syndrome: results of an Italian multicenter study. Eur J Endocrinol. Mayo de 2001;144(5):499-507.
20. Castinetti F, Morange I, Dufour H, Jaquet P, Conte-Devolx B, Girard N, et al. Desmopressin test during petrosal sinus sampling: a valuable tool to discriminate pituitary or ectopic ACTH-dependent Cushing’s syndrome. Eur J Endocrinol. Septiembre 1 de 2007;157(3):271-7.
21. Colao A, Faggiano A, Pivonello R, Pecori Giraldi F, Cavagnini F, Lombardi G, et al. Inferior petrosal sinus sampling in the differential diagnosis of Cushing’s syndrome: results of an Italian multicenter study. Eur J Endocrinol. Mayo de 2001;144(5):499-507.
22. Loriaux DL. Diagnosis and Differential Diagnosis of Cushing’s Syndrome. Longo DL, editor. N Engl J Med. Abril 13 de 2017;376(15):1451-9.
23. Tabarin A, Valli N, Chanson P, Bachelot Y, Rohmer V, Bex-Bachellerie V, et al. Usefulness of Somatostatin Receptor Scintigraphy in Patients with Occult Ectopic Adrenocorticotropin Syndrome. J Clin Endocrinol Metab. Abril de 1999;84(4):1193-202.
24. Tsagarakis S, Christoforaki M, Giannopoulou H, Rondogianni F, Housianakou I, Malagari C, et al. A Reappraisal of the Utility of Somatostatin Receptor Scintigraphy in Patients with Ectopic Adrenocorticotropin Cushing’s Syndrome. J Clin Endocrinol Metab. Octubre de 2003;88(10):4754-8.
25. Kayani I, Bomanji JB, Groves A, Conway G, Gacinovic S, Win T, et al. Functional imaging of neuroendocrine tumors with combined PET/CT using68GaDOTATATE (DOTA-DPhe1,Tyr3-octreotate) and18F-FDG. Cancer. Junio 1 de 2008;112(11):2447-55.
26. Kauhanen S, Seppanen M, Ovaska J, Minn H, Bergman J, Korsoff P, et al. The clinical value of [18F]fluoro-dihydroxyphenylalanine positron emiss

Authors must state that they reviewed, validated and approved the manuscript's publication.  Moreover, they must sign a model release that should be sent.  A copy may be reviewed here

Dimensions


PlumX


Downloads

Download data is not yet available.